Heme/Onc Qs Flashcards
Findings diagnostic of paroxysmal nocturnal hemoglobinuria? (including cell markers)
hemolytic anemia, hypocellular bone marrow, and lack of CD55 and CD59.
idiopathic Bud-Chiari syndrome - test for?
JAK2 mutation
t(9;22)? Treat with?
Philadelphia chromosome. Dasatintib or the imiatinib
HLA-matched platelets would only be used if?
Washing of platelets is reserved for?
history of platelet transfusion refractoriness attributed to platelet alloantibodies
history of a severe allergic reaction (anaphylaxis) to a transfused blood product
Parvovirus B19 infection in sickle cell can present with?
pure red cell aplasia
essential thrombocythemia - treatment? Who gets it?
Hydroxyurea plus low-dose aspirin
Patients older than 60 years, platelet count greater than 1 million/µL, or those with a history of thrombosis.
G6PD stain?
cresyl blue
cryoprecipitate is typically reserved for?
significant bleeding and a fibrinogen level less than 100 mg/dL
Cold agglutinin disease can be confirmed with?
Coombs test
Risk factors for progression of monoclonal gammopathy of undetermined significance to multiple myeloma?
non-IgG M protein, an M protein level of at least 1.5 g/dL, and an abnormal serum free light chain ratio
Discrepancy between urine dip stick (albumin) and Urine protein ratio suggest?
monoclonal FLCs in the urine (Bence-Jones proteinuria) and potential cast nephropathy
classic presentation for CML ?
smear shows?
fatigue; early satiety and progressive weight loss associated with splenomegaly; and a peripheral blood smear demonstrating myelocytes, metamyelocytes, and basophils
IGH/CD1 is the mutation associated with?
PML-RAR protein mutation is associated with?
Mantle cell lymphoma
acute promyelocytic leukemia (APL)
acute promyelocytic leukemia (APL) is clinically associated with?
DIC and thrombocytopenia and NO SPLENOMEGALY
Surgery Hgb goal for sickle cell?
10
Parenteral anticoagulant administration must overlap with warfarin for?
5 days and INR>2 for 24 hours
5-Azacytidine is appropriate therapy for? Why?
higher risk MDS for the purpose of improving blood counts, delaying AML progression, and extending survival.
LGL leukemia is associated with?
RA and Felty’s syndrome
Treatment for malignany associated hyperCa?
Hydration, lasix, steroids, IV bisphosphonate
key component in the initial evaluation of metastatic nonsquamous non–small cell lung cancer?
epidermal growth factor receptor (EGFR) mutation. (improved survival in patients with EGFR mutations who are treated with EGFR tyrosine kinase inhibitors)
Patients receiving long-term immunosuppressive therapy are at greater risk for developing this type of cancer?
NHL
estrogen receptor–positive breast cancer who develop metastases limited to bone after a long disease-free interval should be treated initially with?
aromatase inhibitor.
Postmenopausal patient with newly diagnosed atypical ductal hyperplasia should be offered breast cancer chemoprophylaxis wiht?
exemestane
only chemotherapeutic agent approved for treatment of metastatic melanoma?
dacarbazine
translocation [t(14:18)] Translocation cause overexpression of? Cancer type?
BCL2 oncogene.
Follicular lymphoma
In patients with aggressive breast cancer who develop severe arthralgia while on antiestrogen therapy due to an aromatase inhibitor - try? If fails?
second aromatase inhibitor should be tried; if the arthralgia fails to resolve, tamoxifen should be started.
When to skip imaging despite concern for prostate ca?
Gleason <8, PSA<10
entinel lymph node biopsy should be done for melanomas which are how large?
1 mm thick
Conversion chemotherapy?
given to patients with unresectable tumors in an attempt to shrink the tumor to a resectable size
Women with CUP presenting as abdominal carcinomatosis and ascites - next step?
cytoreductive surgery (assume ovarian cancer)
Overexpression of cyclin D1 suggests?
Mantle cell lymphoma
Women with a personal and family history of ovarian, endometrial, and colon cancer should undergo testing for genetic mutations caused by?
Lynch-syndrome
Agents that are particularly effective in BRCA1-related recurrent ovarian cancers?
PARP inhibitors (-parib)
mycosis fungoides is a form of? Treatment?
cutaneous T-cell non-Hodgkin lymphoma
Early - topical steroids If no response? + retinoids (such as bexarotene) and psoralen plus ultraviolet light (PUVA) therapy, +/-interferon alfa If advanced disease (ie organ involvement)? CHOP and stem cell transplant
Treat squamous cell carcinoma of the neck with?
chemoradiation therapy following surgical resection
Pts with treated cancer of this types should be offered *prophylactic cranial irradiation?
SCLC
For men with multifocal bone pain due to metastatic disease - treatment?
radium-223
1Women who received chest wall radiation (such as mantle radiation therapy for Hodgkin lymphoma) between the ages of 10 and 30 years are at high risk for developing breast cancer and should be screened ?
annual mammograms and breast MRIs.
Patients with a localized gastrointestinal stromal tumor with a relatively higher risk for recurrence should be treated with?
imatinib
Treat a high-grade neuroendocrine tumor of unknown primary site with?
platinum
patients who have imaging that is characteristic of resectable pancreatic cancer - next step?
tissue sampling prior to potential curative resection is not appropriate, and definitive resection without prior tissue confirmation should be pursued.
This is recommended for patients with melanomas of 1- to 4-mm thickness?
Sentinel lymph node biopsy
When to give vitamin K for elevated INR without bleeding?
> 9
